Category: Critical Dietetics

Why I’m doing a dietetic internship.

For the last four months, I’ve been working on something pretty exciting.

When I graduated from my nutrition program, I wrote, very emotionally and fairly defensively, about not being a Registered Dietitian. I wrote about how, even though my original intention in starting school was to become a dietitian, I had discovered that in order to do the type of work I wanted to do (teach people eating competence) I did not actually need to be one. And that some of the things I’d encountered along the way — including the research my peers have done on the experiences of dietetic internship applicants — made me question whether I wanted to be one.

However, at the end of November 2013, I attended a lecture at my alma mater given by a nutrition professor who’d greatly encouraged and inspired me when I was a student. It was my first time back on the university campus since graduation, and I wasn’t sure how I would feel. It was a wonderful evening. The lecture was great, of course, but I was surprised how affected I was by seeing former classmates who had since moved on to being dietitians, catching up with former professors, and meeting new RDs and dietetic interns who were promoting Health at Every Size in their work.

That evening, after reconnecting somewhat with the world I’d left behind, I started to seriously consider applying for a dietetic internship.

First, I love clinical nutrition. I did not know when I began studying nutrition whether I would enjoy clinical subjects at all. As a student, I looked forward to them as a sort of litmus test of whether this field was really for me. It turns out that I did well in those clinical courses. No one was more shocked than me, I assure you. I enjoyed calculating TPN requirements and enteral feeds, even. My experience in the working world bore that out: I really do love clinical nutrition, even though it is not entirely what I came into this field to do.

Second, becoming an RD would solve the difficulty of trying to explain to people and the media exactly who I am and what I do. My position right now, as someone with an accredited degree, specific training, and years of experience — but without that overarching credential — makes this surprisingly confusing. I want it to be clear.

Third, one major reason I did not apply for internship immediately after graduating was because it is beyond me financially. I’m simply not in a position to not work for nine months without any financial aid. This prevented me from applying for a very long time. Ultimately, I decided it was worth it to see if I even had a chance, and then find a way to raise funds.

Fourth, I want to learn more. Nutrition is an ever-changing, complex field. I want to understand it better, have more intensive training, and have the resources to remain current with the research. As a dietitian, I will be able to do this by being a member of my dietetic association and by completing the continuing education requirements that all RDs must fulfill.

The fifth, and most important reason: I originally entered nutrition as a way of doing something positive for fat people. After teaching eating competence for four years, I feel I can serve people in a broader way if I am a Registered Dietitian. I can continue to teach eating competence, but I can also address clinical nutrition concerns when they arise. I am especially interested in finding out how eating competence might be combined with certain therapeutic strategies, as for diabetes.

So, I applied. I went through the fairly harrowing process of gathering references (four wonderful dietitians and one doctor were very helpful with this, you know who you are!), researching internship programs, writing letters, and restructuring my resume. I applied for several programs, I was called for interviews and, two weeks ago, I was successfully matched to an internship.

It was a bittersweet moment, because, on the morning I received the offer, I knew that many qualified and deserving nutrition students were staring at a rejection letter and experiencing the despair, the intense emotional pain, and the personal sense of having done something wrong that comes with it. To those students: you did nothing wrong. This is not your fault. There should be an internship spot for every student who meets the requirements, and I believe there should be financial aid to allow students of various income levels to train as dietitians.

Sadly, I am not in a position to change those things, but while I go forward with joy and excitement to attempt this thing that seemed so impossible to me, I will not forget the very deserving students who have to make other plans.

For now, I must turn my attention to fundraising so that I have the best possible chance to make good this opportunity I’ve been given. The last four months have been a wild ride, and things are only going to get more intense. I hope you’ll wish me luck.

On not being a dietitian.

Just a note – this is a post directed at systemic issues, and specifically the way my field is structured, and is not at all a complaint about the work I do currently, which I love, or about my readers and clients, whom I also love. It’s also an explanation of sorts for the media, who often mistake me for a dietitian.

Many of my fellow dietetics students have expressed similar frustrations. If you don’t live in Ontario, AND you want to tell me to just get over it already and do an internship, since it’s so easy, then please don’t bother commenting. Something like 66% of students who apply for an internship in Ontario this year will not get one, since there are simply not enough spaces. Internship is not included as a part of our degree program, nor is there financial aid available for doing one. It is expected that a person will be in a position to not work for a year in order to afford an internship. I am not.

I am also not expecting to be given an RD credential simply for getting my degree and having some experience – not at all. I believe internship is crucially important – I just also believe that dietetics students in my area have been neglected and forced into a ridiculous bottle-neck that will leave many of them hanging if they don’t happen to be one of the lucky ones. I may very well do an internship when I am able to do so – but when I was graduating, I had a lot of feelings about it, and I wrote them down here. This is not meant as a personal affront to all dietitians everywhere.

So, here’s the thing: I’m not a registered dietitian.

I know it’s confusing, since I have an accredited degree in dietetics, I’m a member of Dietitians of Canada (and formerly of the American Dietetic Association too, but they sent me too much crap in the mail from food and diet companies), I’ve received extra training through DC- and ADA-approved workshops, I’ve attended honest-to-goodness dietetic conferences, and I’ve worked in legit hospitals doing legit clinical nutrition stuff.

But, still, I’m not a dietitian – and I use the generic, mostly meaningless term “nutritionist” to describe myself.

What I am is someone who teaches people about normal, healthy eating.

I teach people to give themselves permission to enjoy food and eat enough to feel satisfied, to have regular, reliable meals, to find out which foods help them to feel good, to pay attention when they eat so that they can enjoy it and learn from it, and to learn to value healthy eating in its own right, because it feels good and makes one’s life better, without it being contingent on weight loss.

Here’s what I don’t do: clinical nutrition. I don’t assess, diagnose, or treat disease with nutritional therapies.

Sometimes my clients, people who want to learn the basics of normal eating, also have diseases with a nutritional component – diabetes, celiac disease, high cholesterol, etc. And I don’t refuse to work with people who have diseases, provided they receive diagnosis, support, and treatment for that disease from a qualified professional – who isn’t me. Because I don’t practice clinical nutrition.

In October I graduated with a science degree that, without the attached RD behind my name, is essentially worthless in my field. I have spent the last nine years not only learning about nutrition at an accredited school, but working in nutrition at various hospitals, and, according to the way the profession is set up in Ontario, I have achieved nothing. I am qualified to do…nothing. Because I have not endured the professional hazing of dietetic internship.

I’m sure you can detect my bitterness.

I am, and always have been, a fan of the scientific method. I believe science is limited in what it can prove, but remains the best way we have to investigate the natural world. Is it perfectly objective? No, but only because it is practiced by hopelessly flawed human beings. But, battered as its practice has been by our nasty little biases, I still love it, and still believe it is the closest we can come to being objective, to learning whatever does exist of universal truth.

I’m a science girl, and a nutritionist in the lay sense of the word. I have a good education, good training, and good experience. The one thing I’m not is a registered dietitian.

When I refer to a dietetic internship as a “hazing,” it’s not because I believe dietitians are mean or evil. In my five years working in various nutrition departments at various hospitals, my bosses have always been dietitians, and I have loved, really loved, them – as people, as practitioners, and as scientists. Because that’s exactly what they are, despite hardly ever being credited as such.

But I’ve also experienced the necessary underbelly of that world. The conveniently gender-, race-, and class-stratified social and professional hierarchies of the clinic. The interpersonal tensions, the brutal systemic limitations. I got my experience, learned what I could learn from the truly remarkable women whose decades of experience made me feel like a tiny speck in a huge, wondrous world; I took my lumps; I jumped through hoops; I got out so I could finish what I started.

Eleven years ago, I decided to study nutrition because I read a passage about normal eating from Ellyn Satter in the book Losing It by Laura Fraser. It was a revelatory answer to the question I’d asked myself – “How should I eat?” – and spent my time and energy searching out, only to find lies, disorder, unscientific thinking, and shameless contortions of logic. I decided then that this – teaching ordinary people to eat normally, based on sound science – was what I wanted to do.

Ellyn Satter was (and is still) a registered dietitian, and I wanted to do what she did – so I set out to become a dietitian and to learn about the science in the answer I’d stumbled upon.

Along the way, I figured out that I may not actually want to be a dietitian, nor did I need to be to do what I’ve wanted to do all along.

So in October, I walked across a stage and took possession of a hard-won piece of paper that made me…nothing. After spending a third of my life and tens of thousands of dollars on this project, I’m no one of consequence to anyone who matters professionally, and may eventually be called a quack and a charlatan because I do a job that hardly anyone in the world does – defending normal eating against the encroachment of a disordered, deeply classist culture, helping ordinary people pick their steps through the muck of anti-intellectual horseshit that is pop nutrition – and I do it audaciously without those two letters, R and D, behind my name.

Because I don’t have the resources, emotionally or financially, to spend a year doing unpaid labour as an intern at the same hospitals that used to pay me by the hour.

I have an education that makes me more qualified than most of the authors who write mass-market diet books – but because I’m not a dietitian, it doesn’t matter. I exist in the gray margins, professionally and scientifically – and our society does not do margins (or shades of gray) very well.

Do I think it’s unfair? Yes. Does it make me angry? Yes. But I accept it for now, because, thankfully, what I do and what I’ve learned still matters a whole lot to me. If you’re reading this, I suspect it matters to you, too.

So, until I figure out all of this big professional mess, I remain

Yours truly,
Not a dietitian.